Medical Concept: Hyphema

Recognition and management of raised intraocular pressure is of paramount importance as bleeding may block the trabecular meshwork of the eye and prevent the normal drainage of aqueous humor leading to secondary glaucoma. Treatment of raised IOP is usually accomplished initially with the use of a topical β-blocker such as 0.5% timolol, which acts to decrease the production of aqueous humour. Topical α2-agonist therapy with an agent such as brimonidine can also be used. Acetazolamide, a carbonic anhydrase inhibitor, also decreases production of aqueous humor at a dose of 500mg IV or PO. Hyperosmolar therapy with mannitol reduces total volume of aqueous humour through the generation…

 Half an 8 ball

When clot fills the anterior chamber it is called an 8-ball hyphema. Over time red cells tend to settle on the bottom of the anterior chamber if the patient is upright. When lying down the hyphema may be detectable as a diffuse haziness in the anterior chamber. A microhyphema is only detectable with a slit lamp.

 Traumatic Hyphema – What is it and how should it be treated?

30% of patient’s with hyphema develop increased IOP which can occur acutely or days after injury, thus close follow up is essential. Patients with sickle cell disease or trait are at high risk for elevated IOP within first 24 hours.

Pediatric EM Morsels

Head of Bed 30-45 degrees, Relative rest / limited activity, Avoiding Aspirin or NSAIDS, Refraining from reading (or watching electronic devices up close) as accommodation can stress the injured vessels, Protective eye shield recommended by some, Close Ophthalmology follow-up (sometimes daily).

Hyphema: its the bloody eye!

Trauma is the most common cause of hyphema. Blunt trauma (such as airbag or fist) is more common than penetrating.

Medical interventions for traumatic hyphema

We found no evidence of an effect on visual acuity by any of the interventions evaluated in this review. Although evidence was limited, it appears that people with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhaging. However, hyphema took longer clear in people treated with systemic aminocaproic acid.

Podcast 521: Traumatic Hyphema

Hyphema are graded between Grade 1 and Grade 5, depending on the amount of blood in the anterior chamber. Higher grades are associated with worse outcomes and more complications, Other important diagnoses to consider include globe rupture and retrobulbar hematoma, Complications of a hyphema can include glaucoma and vision loss.

SGEM#18: Eye of the Tiger (Traumatic Hyphema)

he hyphema is typically a self-limiting condition and is rare to cause permanent vision loss. Many medical treatments have been tried to improve visual outcome and speed up resolution. The most common topical or oral medical is the antifibrinolytics (tranexamic acid or aminocaproic acid) despite being controversial.

The Pearls and Pitfalls of Hyphema

Low IOP and trauma? ---> Rule out globe rupture!

Traumatic Hyphema Symptoms and Treatment

Spontaneous hyphemas occur without inciting trauma and are usually caused by the abnormal growth of blood vessels, vascular anomalies, uveitis, tumors of the eye, rubeosis iridis, hemophilia, leukemia and other conditions or medications that cause thinning of the blood like warfarin or aspirin.